WHAT TO EXPECT
WITH YOUR ANAESTHETIC

Your anaesthetic is designed to keep you comfortable, safe, and free from pain during your operation or procedure so that the operation is as easy and beneficial as possible, for both you and your surgeon.

The choice of anaesthetic type depends on the nature of your surgery, your general health status, and your personal preference. Your anaesthesiologist will offer you the best anaesthetic suited to your wishes and circumstances, as long as it places you at the lowest risk possible.

PRE-OPERATIVELY

(Before your procedure)

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INTRA-OPERATIVELY

(During your procedure)

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POST-OPERATIVELY

(After your procedure)

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HOW SAFE IS
ANAESTHESIA?

Modern anaesthesia is safe but it may still have side effects and complications. The risk of experiencing a complication is affected by the patient’s general state of health, specific medical conditions and the complexity of the procedure.
The information below aims to place these risks in context. Please discuss any queries/concerns with the
anaesthesiologist before your procedure.

Common
Complications

(1 - 10% of cases)

Rare Complications

(Less than 1 in 1000 cases)

Very rare
complications

(1 in 10 000 to 1 in 200 000 cases)

Extremely rare

(Less than 1 in 250 000 cases)

Equivalent to someone in your family

Equivalent to someone in a
village or small town

Equivalent to someone in a
large town or city

Minimal treatment is usually required

May require further
treatment

May be serious with long-
term effects

Often serious with long-
term effects

• Nausea and vomiting
• Sore throat
• Shivering or feeling cold
• Headache
• Dizziness
• Itching
• Pain during drug injection
• Swelling or bruising at the drip site
• Confusion or memory loss

• Injuries to teeth, crowns, tongue, lips, mouth • Hoarseness, vocal cord
damage • Muscle pains
• Difficulty urinating
• Difficulty breathing
• Visual disturbances
• Worsening of underlying medical condition • Side-effects of postoperative medications
• Pressure-related injuries

• Eye injuries
• Nerve injuries causing paralysis
• Awareness under anaesthesia
• Bleeding
• Stroke
• Allergic reactions or anaphylaxis
• Lung infections
• Unexpected drug reactions
• Inherited reactions to drugs (Malignant hyperthermia, Scoline apnoea, Porphyria)

• Death as a direct result of the anaesthetic
• Brain damage
• Heart attacks
• Emboli (clots)
• Hypoxic injury (due to lack of oxygen)

Common
Complications

(1 - 10% of cases)

Rare Complications

(Less than 1 in 1000 cases)

Equivalent to someone in
your family

Equivalent to someone in a
village or small town

Minimal treatment is usually
required

May require further
treatment

• Nausea and vomiting
• Sore throat
• Shivering or feeling cold
• Headache
• Dizziness
• Itching
• Pain during drug injection
• Swelling or bruising at the drip site
• Confusion or memory loss

• Injuries to teeth, crowns, tongue, lips, mouth • Hoarseness, vocal cord
damage • Muscle pains
• Difficulty urinating
• Difficulty breathing
• Visual disturbances
• Worsening of underlying medical condition • Side-effects of postoperative medications
• Pressure-related injuries

Very rare
complications

(1 in 10 000 to 1 in 200 000 cases)

Extremely rare

(Less than 1 in 250 000 cases)

Equivalent to someone in a
large town or city

May be serious with long-
term effects

Often serious with long-
term effects

• Eye injuries
• Nerve injuries causing paralysis
• Awareness under anaesthesia
• Bleeding
• Stroke
• Allergic reactions or anaphylaxis
• Lung infections
• Unexpected drug reactions
• Inherited reactions to drugs (Malignant hyperthermia, Scoline apnoea, Porphyria)

• Death as a direct result of the anaesthetic
• Brain damage
• Heart attacks
• Emboli (clots)
• Hypoxic injury (due to lack of oxygen)

Complications that may occur due to procedures that may be performed during your anaesthetic:

Procedure

Complication

Intravenous line (IV)

Pain, swelling, bleeding, inflammation, infection, clots, repeated insertions if
IV not working adequately

Central line for monitoring or therapy (CVP)

Pain, swelling, bleeding, inflammation, infection, repeated insertions,
puncture of lung, artery or nerve, clots

Arterial line for specialised monitoring (A-line)

Pain, swelling, bleeding, inflammation, infection, repeated insertions, loss of
blood flow to the hand leading to death of fingers

Airway management

Damage to lips, teeth, tongue, palate, throat, vocal cords, hoarseness,
inhalation of stomach contents (aspiration), pneumonia, obstruction
of breathing, and failure to maintain the airway requiring an operative
procedure.

Nerve blocks, spinal or epidural injection

Back pain, non-resolving headache, nerve damage, paralysis, headache,
nausea, vomiting, infection, dizziness, shortness of breath, chest pain,
pneumothorax, seizures, and drug toxicity.

USEFUL LINKS

South African Society of Anaesthesiologists “For patients”:

Royal College of Anaesthetists: Anaesthesia explained - Information for Patients

Royal College of Anaesthetists: You and your anaesthetic - Information to help patients prepare for anaesthetic

PRE-OPERATIVELY

MEDICAL HISTORY

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  • Your anaesthesiologist must be aware of any medical conditions you have, and any problems you previously had with anaesthesia.

  • Dr Steyl would like to encourage her patients to make use of the Perioperative Shared Health Record (PSHR) to record
    their medical history for her to review in advance of their hospital admission.

  • Alternatively, patients can complete the green Anaesthetic Record which is usually available in the hospital ward and
    can be completed after admission.

  • If you have any medical reports, feel free to bring them with you when you are admitted.

  • Dr Steyl endeavours to see her patients in the ward before the start of a list, but please note that if the surgeon offers
    you an admission time after the starting time of a list, you may only see Dr Steyl in the theatre waiting area shortly
    before the procedure. This is because once an anaesthesiologist starts a case in theatre, they cannot leave that patient unattended.

MEDICATION

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  • If possible, please make a list of all the medications that you take regularly, including homeopathic or natural medications.

  • Make a note of any allergies that you have especially to medications.

  • If you use inhalers for a lung condition, please bring these with you to the hospital.

  • If you take medication that is time sensitive (for example medication for Parkinson’s disease), please bring this along to the hospital, together with instructions for how and when you take this medication.

  • If you are pregnant or breastfeeding, please inform your surgeon and anaesthesiologist so that medications may be chosen that are the safest for you and your baby.

  • Medication that may be taken on the day before and the day of your procedure:

    • All heart medications
    • Low-dose Aspirin (80 or 100mg per day)
    • Blood pressure medications (Except ACE-Inhibitors like perindopril, and ARBs like valsartan)
    • Thyroid medication (Eltroxin, Euthyrox)
    • All epilepsy medications
    • All asthma drugs and inhalers
    • Gastric acid-reducing tablets (e.g., omeprazole, lansoprazole, ranitidine)
    • Any tranquilisers that are taken regularly at home
    • Antidepressants (except Lithium and Moclobemide)
    • All steroids taken regularly, including inhalers
    • All immunosuppressant drugs and cancer drugs
    • All antiviral drugs
  • Medications that should be omitted on the day of surgery:

    •   Angiotensin-Converting-Enzyme-Inhibitors (blood pressure medication), for example, ramipril (Ramiwin, Titrace), enalapril (Enap-Co), perindopril (Coversyl, Coveram, Prexum), captopril (Capoten), lisinopril (Zestril, Zestoretic). Omit 24 hours before surgery.

    •   Angiotensin-2 Receptor Blockers (blood pressure medication), for example candesartan (Atacand), losartan (Cozaar), valsartan (Diovan). Omit 24 hours before surgery.

    •   Diuretics (water tablets): furosemide (Lasix), amiloride (Dapamax), spironolactone (Spiractin). Omit on the day of surgery.

    •  Oral diabetic medication: omit on the morning of surgery.

    •  Insulin: Discuss with your physician or your anesthesiologist regarding the best management.

    •  Anticoagulants (blood thinners): higher dose Aspirin (more than 100mg/day), clopidogrel (Plavix, Clopiwin), rivaroxaban (Xarelto), warfarin, enoxaparin (Clexane).

    •  Lithium (Camcolit) and Moclobemide (Depnil). Omit on the day of surgery.

    •  Non-steroidal anti-inflammatory drugs (NSAIDs), like diclofenac (Voltaren), etoricoxib (Arcoxia), celecoxib (Celebrex), indomethacin (Indocid), ibuprofen (Brufen). Omit 24 hours before surgery. These drugs may increase your bleeding risk.

    •  Viagra (Sildenafil), Cialis (tadalafil), Levitra (Vardenafil) – these should all be omitted for 24 hours before your surgery. These medications may affect your blood pressure during anesthesia.



  • Please inform our surgeon and your anaesthetist that you are taking blood thinning medication as soon as you know that you are booked for surgery. You may need to stop the medication a few days in advance of your procedure. In select cases, you may need to be admitted a few days before your procedure to manage your bleeding and clotting risk.

MEDICAL EQUIPMENT

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  • If you use a home CPAP mask, please bring your mask and device to the hospital with you so that you can use it after
    the operation.

WHAT YOU MAY EAT
AND DRINK

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  • All patients must fast before any anaesthetic or sedation is given. This prevents stomach contents from being aspirated
    and causing lung damage.

  • In general, the fasting guidelines are as follows:

Adults

Meat and fried foods

Up to 8 hours before the planned procedure.

Light meal
Toast
Dairy Products

Up to 6 hours before the planned procedure.

Clear fluids
(Water, black tea/coffee, apple juice, grape juice)
*Note: Jelly is not considered a clear liquid

Up to 2 hours before the planned procedure.

Children

Solid food
Cow’s milk
Formula milk
Fortified milk

Up to 6 hours before the planned procedure.

Breast Milk

Up to 4 hours before the planned procedure.

Clear fluids
(Water, black tea/coffee, apple juice, grape juice)
*Note: Jelly is not considered a clear liquid

Up to 1 hour before the planned procedure.

TIMING
OF YOUR OPERATION

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  • Although your case may be scheduled to start at a particular time, it is not always possible to guarantee that starting time. Only one patient can be anaesthetised and operated on at a time. If a particular procedure takes longer than expected, or if there are complications, or an emergency add-on the patients following after that case may have their procedures delayed, sometimes by a few hours.

  • Wherever possible, your surgeon and anaesthesiologist will try to inform the ward of unexpected delays, to allow you to take in clear fluids for a bit longer before your planned surgery.

INTRA-OPERATIVELY

Different types of anaesthesia techniques can be used individually or in combination. Each patient will have an anaesthetic treatment plan based on their medical background and risk profile. The aim is to achieve the safest anaesthetic for each patient.

GENERAL ANAESTHESIA
(GA)

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  • This is when the anaesthesiologist puts you into a state of controlled unconsciousness. You are not aware of anything during the procedure.

  • This is usually achieved by injecting induction medication into a vein, but sometimes anaesthesia is induced by inhalation of anaesthetic vapours (gases).

  • Patients can be kept asleep with either anaesthetic vapours that are inhaled through an airway device (inhalational anaesthesia), or with intravenous agents that are slowly infused into a vein for the duration of the procedure (total intravenous anaesthesia).

REGIONAL ANAESTHESIA
(RA)

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  • Local anaesthetic agents are injected near specific nerves. This can be with a spinal injection, an epidural injection, a nerve plexus block, or a peripheral nerve block.

  • Whole body parts can be made numb in this way.

  • Depending on the procedure and your preference, you may be awake or lightly sedated, but you will not have any sensation or pain in the area that has been blocked.

  • A spinal injection is a once-off injection into the lower back, to temporarily paralyse the nerves of the spinal cord. This produces numbness in the lower half of the body. A spinal injection is quick to insert and can give pain relief for anything from 4 – 12 hours, depending on the medications injected.

  • An epidural injection can be into either the lumbar or thoracic spine and usually involves leaving a small catheter in place for up to 3 days to give continuous local anaesthetic medication. An epidural catheter takes a bit more time to insert than a spinal injection, but the benefit is a longer duration of pain relief.

  • Plexus or peripheral nerve blocks target specific nerves or specific areas of the body.

PROCEDURAL SEDATION
AND ANALGESIA (PSA)

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  • Oral medication, injectable agents or anaesthetic vapours are used to keep you calm and drowsy, but you are still breathing on your own and you can be easily woken up.

  • The depth of your sedation will depend on the procedure you are coming for, and on your baseline condition.

  • Gastroscopies and colonoscopies are often done under sedation.

  • It is still important to follow the fasting rules, even if you are only having sedation.

  • Not all patients are candidates for sedation.

POST-OPERATIVELY

PAIN RELIEF

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Dr Steyl will discuss possible strategies and medications for pain relief with you.

It is usually best to use a combination of agents that target different receptors responsible for pain sensation. Not all medications agree with all patients; if you know that some medications give you side effects, please discuss this with Dr Steyl in advance.

PREVENTION OF NAUSEA
AND VOMITING

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Dr Steyl usually prescribes medication to prevent nausea and vomiting to her patients based on their risk profile.

If you know that you have had previous postoperative nausea and vomiting, please discuss this with Dr Steyl in advance that she may plan appropriately.

FOLLOW-UP

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The surgeon remains primarily responsible for your post-operative care. In some cases, Dr Steyl may also follow up with you, especially if you had an epidural catheter placed, or if you were admitted to the intensive care unit.

PLEASE NOTE

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  • You are strongly advised not to drive, operate dangerous machinery or make important decisions in the 24 hours following your anaesthetic.

  • Please do not post anything on social media in the 24 hours after your anaesthesia.

  • If you are likely to be discharged home within 24 hours of your procedure, please arrange for a family member or friend to collect you and take you home.

  • Do not consume alcohol in the 24 hours after your anaesthetic, or while taking medication prescribed after your procedure (especially painkillers and antibiotics).

  • Female patients, please note that some agents used in anaesthesia may render oral contraceptives ineffective. If you have received such an agent or are unsure, please use additional contraceptive measures for the remainder of your cycle.

ADVICE FOR PREGNANT AND
BREASTFEEDING PATIENTS

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  • Please make sure to use only the prescribed medication in the postoperative period. If you are unsure whether a medication is safe to use in pregnancy, please consult your surgeon, anaesthesiologist or gynaecologist.

  • General anaesthesia does not normally affect breastfed babies. It is recommended that you breastfeed up until the operation, and continue breastfeeding as soon as you are awake and feel ready to do so after the procedure. Very small amounts of anaesthetic medication may pass into breast milk, however, there is no need to “pump and dump”.

  • Please ensure that you have help to look after your child for the first 24 hours after surgery. Ideally, you should not be the primary caregiver for your child for the first 24 hours after anaesthesia.